Hypothetically Speaking, a fiver
The Bean's Dad | March 20Our previous installment raised a few hackles (make sure to read all the comments) and demonstrated that around the world people balance different risks in protecting their children. And apparently, being able to bring and/or use a AAP approved car seat is a luxury not everyone has.
Damn, it’s amazing that humans have made it this long, eh?
{I believe Continental Airlines gives like a 50% discount for kids under 2 or 3 for their own seat on the plane. Anybody know of other ways to save a buck or two while travelling with kids?}
This week we visit the doctors’ office.
Your child is ill. Her symptoms include fever, runny nose, eye gunk and slight cough. It’s been like this for 36 hours so you take her to the morning drop-in hours at the doctors’ office where you happen to see your regular pediatrician. After checking the kids’ vitals for 30 seconds, she gives you a diagnosis of a virus for which you can’t do much and pink eye with a prescription for eye drops.
Three days later it appears the pink eye is nearly gone but everything else is worse. You head back to the doctor’s office. Your regular pediatrician is out so you see a new doc. The doctor asks a lot of questions and takes her time checking out your kid. This time you get a diagnosis of an ear infection including an explanation of how the eyes, nose and ears are all interconnected. This makes eye gunk a symptom of an ear infection. Two doses of the antibiotics and 24 hours later your kid looks and feels brand new.
Please don’t miss the forest for the trees. Let’s discuss this as the hypothetical situation I’d like it to be.
Some leading suggestions for discussion:
Ignore it and hope for the best next time.
Or switch doctors.
Feel free to expand, expound and qualify.
Me personally, I’d switch doctors. I’m assuming that all of these pediatricians are within the same practice? You could probably just make your future appointments with the new doctor, and tell her how impressed you were with her level of care without trashing the other pediatrician. I find it surprising that an ear infection would be so easily missed the first time around, since that is one of the ills that young kids so frequently come in with. But I wouldn’t bring it up to the other doctor at all - I would just make sure that my kid got the most attentive care the next time around with the new doctor.
It would depend on my regular ped’s track record. If s/he’s given accurate diagnoses in the past, I wouldn’t switch docs but would be more diligent the next time we went in for a sick visit… like mentioning the prior mis-diagnosis and ask for a slightly more thorough check-up. I would most likely (as I always do) do my own research on the symptoms PRIOR to the visit so I am slightly more informed and can ask the right questions.
Even doctor’s make mistakes. I remember one of my own docs telling me years ago that’s why they “practice” medicine. ;)
My kids have gotten lots of ear infections over the past 5 years or so. I know that we can go in one day and there is liquid behind the ear drum then 2 days later we will be going back in and they will now be infected. We got to the point of purchasing an ear checking thingy the dr uses and my wife is about as good as the DR in finding ear infections.
My point is no matter who your dr is know what the symptoms are and what that can represent. And always ask about the ears if they have a cold. Also if you feel like your getting sub par care then absolutely switch, but 1 missed ear infection doesn’t make a bad DR.
I’d probably switch. I guess it depends. I live in a place where there are a ton of good pediatricians close to our house. Unless you have had great luck with this doctor in the past - it seems like a big one to miss. Especially since it seems like an obvious thing to look for.
Nothing ticks me off more than withholding antibiotics on the first visit, thus insuring the second visit. I understand why they don’t want to give them out like aspirin, but c’mon docs, we parents don’t have unlimited time to sit in the waiting rooms. Ugh.
I don’t know that switching doctors will help. It seems like most of them are going to say that it’s a virus on the first visit. I’ll bet your regular doctor would have prescribed antibiotics on the second visit as well. But if you don’t like him/her, this is as good a reason as any to switch.
It depends on your feel towards medicine, you have to find a doctor whose treatment style and bedside maner match your own. I used to tell my wife, it it not just about finding a good doc, but about finding the right good doc. If you are one of those who believes a doc should “drug first, ask questions later,” find a good doc who operates like that. If you want a good doc is is business like, but prefers alternative therapy you need to find that doc.
Our doc says “When you hear hooves out the window, think horses first then zebras.” If there is a cold going around and the symptoms matched the cold then he would wait to see if it acted like the cold. Sure we would have ended up going back, but do you really want to fill your kid with drugs until you know for sure?
The second doc had an additional piece of information that the first doc didn’t have, namely that you had visited three days earlier and that everything had gotten worse. If the order had been reversed, you probably would have gotten the same treatment (i.e. check virus first, ear infection second) - no ear pain noted in either scenario, which would be a dead giveaway.
That said, the second doc sounds like they have a better bedside manner - if not necessarily better outcomes. All things being equal - go with the doc that matches your treatment philosophy first (throw the drug kitchen sink at a problem vs. minimal pharmaceutical intervention, let nature take it’s course) and then the one who makes you feel better.
Just make sure to ask lots of questions. Doctors usually have reasons for doing what they do… and if for some reason they don’t, then you should switch doctors!
I smell a lawsuit. There just isn’t enough legal action taken these days.
Well I’m in the UK, so a) it’s free to go to the doctor, and b) we go to a GP rather than a paed specialist as a first call.
We have a GP Practice of about 6 doctors. One of whom I always take my son to if at all possible, as he’s been qualified a long time, has a great way with kids(babies), and is thorough to the point of being a pedant - but he gets to the bottom of things and doesn’t oversubscribe. But he can be a bit slow and I don’t find him very genuine if I see him for something myself. And one doc whom I go to if I just need a script - as it’s a lady doctor (less embarrassing!), she’s a bit more relaxed and friendly, but I wouldn’t go to if I was *really* ill as she has missed things in the past and isn’t thorough enough with babies and kids.
As per the advice above, “horses first, then zebras”. I nearly took a GP to court for un-diagnosed stroke (in me, an otherwise healthy 30yr old woman). He sent me home 3 visits in a row with pain killers. Yes, he should have diagnosed the stroke, but I was too unwell to describe the symptoms better. But because of the lack of patient rapport and continuity of treatment with one doc, he didn’t realise my behaviour was abnormal (indicating stroke). It wasnt until a friend of 15yrs saw me, and as a GP packed me off to the hospital, that I got treated. The doctor can only make a diagnosis on what he/she can see at that time. He saw horses.
Go on your gut feeling about changing doc - maybe a 3 strikes they’re out? From your post it sounds like the regular guy might be a bit hasty and make too many assumptions, rather than diagnose
I always ask for things if the doc isn’t doing them (not my regular Ped.; he’s awesome. Sometimes we have to go to Urgent Care when my son’s breathing isn’t being controlled at home). Like, “Check his ears, please,” or, “Something isn’t right, I want a chest x-ray,” (which led to finding double pneumonia when the doc intially said, “Virus.”).
There’s nothing at all wrong with acting like a consumer when it comes to medical care, if you feel like you’re being shafted.
Having been a person who was misdiagnosed for something incredibly serious (and didn’t sue, incidentally), I tend to err on the side of caution. I think bluepaolo has a good point in that doc #2 had more information and could make a better assessment. I personally love our family physician (NOT the one who misdiagnosed me) and know that some days he is more “on” than others, but he always takes the time to ask questions and let me ask them too. If I feel he is rushing out, I will ask another question-one that involves more than just taking vitals or peeking at the chart-and make it a point to get everything answered. After all, isn’t that what we pay them to do?
Socialized medicine–switching is not a very real option over here. Nor will it help, in this situation. I think the “it’s viral” diagnosis on the first visit is a universal thing. I try to let the Doctor know that I am not falling for the virus idea this time and could we please get the goods that will make my child feel better. Now. Hey, doc. Ya don’t wanna get the mama mad.
1.) Pediatric ear infections don’t pop up on their own; in general, they begin as a viral infection, which then causes congestion and irritation and allows a bacterial infection to develop. The initial diagnosis of upper respiratory (yeah, that detail’s not listed, but I know I’m right) viral infection which then developed into an ear infection sounds spot on. If anything, the second physician could have spared you some frustration by explaining why the second diagnosis differed from the first.
2.) Well over 90% of ear infections resolve spontaneously. Average time course is in the (ta da!) 3-5 day range.
3.) 2 doses/24 hours of abx cured it? Really? I’d suggest the most likely scenario is your little one’s immune system did its job. Hope you didn’t spend too much on the medication, and please complete the course once you’ve started.
I’d switch.
In my 22 years of being a mother and going to doctors myself, I have learned how much it means to spend the time and ask the questions and explain the treatment and all that. Very Valuable (with capital V’s) and makes a big difference in overall effectiveness of health management.
i try to find something at google.com and take it on your site…thanks
Great job guys… Thank for you work…